From epidemic to pandemic

As COVID-19 spreads across the globe, Ian Peate discusses its challenges and emergency response

When outbreaks of infectious diseases occur, they bring with them periods of great uncertainty. As events develop, resources and capacities that are often limited will be stretched even further, and decisions regarding a public health response are usually made quickly, despite the likelihood that the evidence for decision-making may be limited (World Health Organization (WHO), 2016). When such situations arise, public health officials, policy-makers, healthcare workers and public health practitioners require guidance as they make complex bioethical decisions.

Previously, the WHO had talked only of the ‘threat’ or ‘potential’ for a pandemic; however, with cases in more than 100 countries and increasing numbers not linked to travel, the WHO declared the COVID-19 outbreak as pandemic on 11 March (WHO, 2020). It is anticipated in the days and weeks ahead that the number of cases, deaths and affected countries will continue to climb, yet higher.

Coronaviruses are a large family of viruses; they are common globally, responsible for a variety of illnesses, ranging from the common cold to more severe respiratory infections; for example, pneumonia. They are ‘zoonotic’, sometimes being transmitted between animals and humans. The new strain named by the WHO as COVID-19 includes symptoms of cough, a high temperature and shortness of breath. Generally, symptoms are more severe in those with compromised immune systems, in particular, the elderly and those with long-term conditions such as, cancer, diabetes and chronic lung disease.

If countries detect, test, treat, isolate, trace and mobilise their people as a response, this can prevent cases becoming clusters and those clusters becoming community transmission. A number of countries have demonstrated that the virus can be suppressed and managed. However, there are challenges as some countries struggle with a lack of capacity, a lack of resources—and a lack of determination.

Measures taken in response to the virus are taking a heavy toll on societies and economies globally. There is a fine balance between the protection of health, reducing economic and social disruption, as well as continuing to respect human rights.

Working together across sectors locally, nationally and internationally can mitigate the social and economic consequences of this pandemic—but this requires every sector and individual to engage and become involved. A whole-of-government, a whole-of-society, approach is advocated by the WHO—one that is built around a comprehensive strategy to prevent infections, save lives and minimise impact.

Countries around the world are being called upon to activate and scale up emergency response mechanisms, improve communications and inform people about the risks and how they can protect themselves, emphasising that this is everybody's business.

Paramedics have a key role to play in helping to treat and contain this virus and they are likely to face an increased burden in helping to get through the outbreak. Public health organisations, government health officials and employers are putting in place and activating plans to ensure that people receive the right advice, care and support and that all health and social care workers have the best information, environment and equipment to do their job. Many frontline responders who are routinely challenged during epidemic outbreaks provide valuable contributions as they prevent and avert potential, catastrophes.

Paramedics recognise that the first concern will be the care of patients. Paramedics, working in partnership with each other and service users, use their professional judgement to assess risk to deliver safe care that is informed by any relevant guidance and the values and principles that are set out in professional standards and codes of conduct. It is important that everyone continues to follow national public health advice and guidance.

Let's all look out for each other—we need each other.